Relationship between clinicopathological characteristics and prognosis of HIV-infected breast cancer patients

doi:10.3877/cma.j.issn.1674-0807.2023.03.004

Abstract

Abstract:

Objective

To study the clinicopathological characteristics, treatment and prognosis of HIV-infected breast cancer patients.

Methods

We conducted a retrospective cohort analysis of 19 HIV-infected breast cancer patients (HIV-infected group) in the Department of General Surgery, Shanghai Public Health Clinical center from August 2016 to January 2022. Another 174 breast cancer patients who were not infected by HIV (non-HIV-infected group) admitted in the same hospital from November 2016 to May 2021 served as controls. By propensity score matching (PSM) at 1∶2, 38 cases were obtained from non-HIV-infected group. The Kaplan-Meier method was applied to develop survival curves, and the Log-rank test was used to compare disease-free survival (DFS) and overall survival (OS) between two groups. The Cox proportional risk regression model was used for univariate and multivariate analyses.

Results

The median follow-up time was 24 months. All patients were treated with standardized HARRT therapy. Before PSM, compared with the HIV-infected group, the non-HIV-infected group showed higher rates of hormonal receptor(HR) positivity, low Ki-67 expression, 0-Ⅱ stage tumor and no metastasis in axillary lymph nodes (P=0.034, 0.048, 0.026; χ²=4.499, P=0.034). After PSM, there was no significant difference in the baseline data between two groups, but the DFS and OS presented a significant difference (χ²=8.295, P=0.004; χ²=12.759, P<0.001). Univariate Cox analysis showed that HR expression was related to DFS (HR=0.115, 95%CI: 0.013-0.991, P=0.049), and HIV infection was related to both DFS and OS (HR=6.101, 95%CI: 1.510-24.657, P=0.004; HR=17.682, 95%CI: 2.049-152.565, P<0.001). Multivariate analysis showed that HIV infection was related to both DFS and OS (HR=7.891, 95%CI: 1.715-36.322, P=0.008; HR=37.796, 95%CI: 2.338-611.103, P=0.011).

Conclusion

HIV-infected breast cancer patients have a poor prognosis.

Key words: Breast neoplasms, Human immunodeficiency virus, Prognosis

Qian Wu, Li Deng, Shixian Lian, Hua Zhang, Ying Jiang, Hongwei Zhang. Relationship between clinicopathological characteristics and prognosis of HIV-infected breast cancer patients[J]. Chinese Journal of Breast Disease(Electronic Edition), 2023, 17(03): 151-156.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhrxbzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-0807.2023.03.004

https://zhrxbzz.cma-cmc.com.cn/EN/Y2023/V17/I03/151

Figures/Tables 5

References 16

[1]	Ceccarelli M, Venanzi RE, Marino MA, et al. Non-AIDS defining cancers: a comprehensive update on diagnosis and management[J]. Eur Rev Med Pharmacol Sci, 2020，24(7):3849-3875.
[2]	Arts EJ, Hazuda DJ. HIV-1 antiretroviral drug therapy[J]. Cold Spring Harb Perspect Med, 2012，2(4):a7161.
[3]	Coghill AE, Shiels MS, Suneja G, et al. Elevated cancer-specific mortality among HIV-infected patients in the United States[J]. J Clin Oncol, 2015，33(21):2376-2383.
[4]	Patel P, Hanson DL, Sullivan PS, et al. Incidence of types of cancer among HIV~infected persons compared with the general population in the United States, 1992－2003[J]. Ann Intern Med, 2008，148(10):728-736.
[5]	Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin. 2021，71(3):209-249.
[6]	Jiang Z, Li J, Chen J, et al. Chinese Society of Clinical Oncology (CSCO) Breast Cancer Guidelines 2022 [J]. Transl Breast Cancer Res，2022，3: 13.
[7]	覃亚勤，罗凤，黎彦君，等. 艾滋病合并恶性肿瘤住院患者疾病谱分析[J/CD]. 新发传染病电子杂志，2022，7(1):39-42.
[8]	Brandão M, Bruzzone M, Franzoi MA, et al. Impact of HIV infection on baseline characteristics and survival of women with breast cancer[J]. Aids, 2021，35(4):605-618.
[9]	Bense RD, Sotiriou C, Piccart-Gebhart MJ, et al. Relevance of tumor-infiltrating immune cell composition and functionality for disease outcome in breast cancer[J]. J Natl Cancer Inst, 2017，109(1): djw192.
[10]	Cubasch H, Joffe M, Hanisch R, et al. Breast cancer characteristics and HIV among 1，092 women in Soweto, South Africa[J]. Breast Cancer Res Treat, 2013，140(1):177-186.
[11]	Coghill AE, Han X, Suneja G, et al. Advanced stage at diagnosis and elevated mortality among US patients with cancer infected with HIV in the National Cancer Data Base[J]. Cancer, 2019，125(16):2868-2876.
[12]	Robbins HA, Pfeiffer RM, Shiels MS, et al. Excess cancers among HIV-infected people in the United States[J]. J Natl Cancer Inst., 2015；107(4):dju503.
[13]	郑莹，吴春晓，张敏璐. 乳腺癌在中国的流行状况和疾病特征[J]. 中国癌症杂志，2013，23(8):561-569.
[14]	Singh SN, Zhu Y, Chumsri S, et al. Outcomes and chemotherapy-related toxicity in HIV-infected patients with breast cancer [J]. Clin Breast Cancer，2014，14(2):e53-e59.
[15]	Vaccher E, Spina M, di Gennaro G, et al. Concomitant cyclophosphamide, doxorubicin, vincristine, and prednisone chemotherapy plus highly active antiretroviral therapy in patients with human immunodeficiency virus-related, no-Hodgkin lymphoma[J]. Cancer, 2001，91(1):155-163.
[16]	Levine AM. Evaluation and management of HIV-infected women[J]. Ann Intern Med, 2002，136(3):228-242.

变量	变量类型	赋值
年龄	X₁	<50岁＝1；≥50岁＝2
激素状态	X₂	阴性＝1；阳性＝2
HER-2状态	X₃	阴性＝1；阳性＝2
Ki-67	X₄	低表达＝1；高表达＝2
是否浸润	X₅	原位癌＝1；浸润性癌＝2
区域淋巴结转移	X₆	无＝1；有＝2
TNM分期	X₇	0、Ⅰ、Ⅱ期＝1；Ⅲ、Ⅳ期＝2
分子分型	X₈	luminal A型＝1；luminal B型＝2；HER-2过表达型＝3；三阴型＝4
HIV感染	X₉	无＝1；有＝2
疾病进展	Y₁	无进展＝0；复发、疾病进展或死亡＝1
生存结局	Y₂	生存＝0；死亡＝1

变量	变量类型	赋值
年龄	X₁	<50岁＝1；≥50岁＝2
激素状态	X₂	阴性＝1；阳性＝2
HER-2状态	X₃	阴性＝1；阳性＝2
Ki-67	X₄	低表达＝1；高表达＝2
是否浸润	X₅	原位癌＝1；浸润性癌＝2
区域淋巴结转移	X₆	无＝1；有＝2
TNM分期	X₇	0、Ⅰ、Ⅱ期＝1；Ⅲ、Ⅳ期＝2
分子分型	X₈	luminal A型＝1；luminal B型＝2；HER-2过表达型＝3；三阴型＝4
HIV感染	X₉	无＝1；有＝2
疾病进展	Y₁	无进展＝0；复发、疾病进展或死亡＝1
生存结局	Y₂	生存＝0；死亡＝1

临床病理特征	匹配前				匹配后
临床病理特征	HIV组(n＝19)	非HIV组(n＝174)	检验值	P值	HIV组(n＝19)	非HIV组(n＝38)	检验值	P值
年龄
<50岁	8	54	χ²＝0.963	0.326	8	14	χ²＝0.148	0.700
≥50岁	11	120	χ²＝0.963	0.326	11	24	χ²＝0.148	0.700
HR表达
阳性	11	141		0.034^a	11	17	χ²＝0.877	0.349
阴性	8	33		0.034^a	8	21	χ²＝0.877	0.349
HER-2表达
阳性	7	45	χ²＝1.049	0.306	7	14	χ²＝0.000	1.000
阴性	12	129	χ²＝1.049	0.306	12	24	χ²＝0.000	1.000
Ki-67
高表达^b	18	127		0.048^a	18	35		1.000^a
低表达	1	47		0.048^a	1	3		1.000^a
是否浸润
原位癌	1	16		1.000^a	1	5		0.652^a
浸润性癌	18	158		1.000^a	18	33		0.652^a
区域淋巴结转移
有	11	58	χ²＝4.499	0.034	11	12	χ²＝3.645	0.056
无	8	116	χ²＝4.499	0.034	8	26	χ²＝3.645	0.056
分子分型
luminal A型	1	42		0.045^a	1	1		0.761^a
luminal B型	10	99			10	16
HER-2过表达型	4	16			4	9
三阴型	4	17			4	12
TNM分期
0、Ⅰ、Ⅱ期	13	154		0.026^a	13	33		0.153^a
Ⅲ、Ⅳ期	6	20		0.026^a	6	5		0.153^a

临床病理特征	匹配前				匹配后
临床病理特征	HIV组(n＝19)	非HIV组(n＝174)	检验值	P值	HIV组(n＝19)	非HIV组(n＝38)	检验值	P值
年龄
<50岁	8	54	χ²＝0.963	0.326	8	14	χ²＝0.148	0.700
≥50岁	11	120	χ²＝0.963	0.326	11	24	χ²＝0.148	0.700
HR表达
阳性	11	141		0.034^a	11	17	χ²＝0.877	0.349
阴性	8	33		0.034^a	8	21	χ²＝0.877	0.349
HER-2表达
阳性	7	45	χ²＝1.049	0.306	7	14	χ²＝0.000	1.000
阴性	12	129	χ²＝1.049	0.306	12	24	χ²＝0.000	1.000
Ki-67
高表达^b	18	127		0.048^a	18	35		1.000^a
低表达	1	47		0.048^a	1	3		1.000^a
是否浸润
原位癌	1	16		1.000^a	1	5		0.652^a
浸润性癌	18	158		1.000^a	18	33		0.652^a
区域淋巴结转移
有	11	58	χ²＝4.499	0.034	11	12	χ²＝3.645	0.056
无	8	116	χ²＝4.499	0.034	8	26	χ²＝3.645	0.056
分子分型
luminal A型	1	42		0.045^a	1	1		0.761^a
luminal B型	10	99			10	16
HER-2过表达型	4	16			4	9
三阴型	4	17			4	12
TNM分期
0、Ⅰ、Ⅱ期	13	154		0.026^a	13	33		0.153^a
Ⅲ、Ⅳ期	6	20		0.026^a	6	5		0.153^a

变量	总生存率		无瘤生存率
变量	HR(95%CI)	P值	HR(95%CI)	P值
年龄
<50岁	1.000		1.000
≥50岁	1.320(0.210~8.309)	0.767	0.802(0.154~4.166)	0.793
HR状态
阴性	1.000		1.000
阳性	0.149(0.017~1.350)	0.090	0.115(0.013~0.991)	0.049
HER-2状态
阴性	1.000		1.000
阳性	1.694(0.237~12.126)	0.600	2.354(0.388~14.157)	0.353
Ki-67
低	－	－	1.000
高	－	－	21.799(0~1.748)	0.877
是否浸润
原位癌	1.000		1.000
浸润癌	22.442(0~6.281)	0.800	22.542(0~5.126)	0.719
区域淋巴结转移
无	1.000		1.000
有	5.341(0.581~49.115)	0.139	6.344(0.723~55.493)	0.096
TNM分期
早期	1.000		1.000
晚期	3.788(0.616~23.308)	0.151	2.704(0.537~13.627)	0.228
分子分型
luminal A型	1.000		1.000
luminal B型	0.167(0.015~1.894)	0.149	511.607(0~2.143)	0.976
HER-2过表达型	1.270(0.145~11.158)	0.829	6 119.637(0~2.533)	0.966
三阴型	－	－	3 121.998(0~1.304)	0.969
HIV状态
无	1.000		1.000
有	17.682(2.049~152.565)	<0.001	6.101(1.510~24.657)	0.004

Please choose a citation manager

Content to export